Global Statistics

Global Statistics


Making the Choice

Three years ago during a routine exam, I was diagnosed with uterine fibroids. At that time, I was 48 years old and in very good health. Since I did not have any of the symptoms often associated with fibroids, such as abnormal bleeding, pain or incontinence, my gynecologist suggested that we simply “watch and wait.” I knew very little about fibroids, so I decided to read books and articles on the subject. I found out that hysterectomy is often the solution for fibroids but that there are other more conservative approaches.

About a year after my exam, I began to experience incontinence and heartburn because the growing fibroid tumors were pressing on my organs. My abdomen enlarged so much that I looked pregnant. When I went back to my physician, he did a sonogram and said that I was a good candidate for a hysterectomy. I had asked about having a less drastic procedure in which only the fibroids are removed (myomectomy), but my doctor said it was an option only for younger women who were still planning on having children.

At this point, I was seriously considering having a hysterectomy because my symptoms were making me uncomfortable. But a nagging voice inside urged me to get a second opinion. After all, the fibroids weren’t cancerous, and they weren’t causing heavy bleeding or pain. First, I went to see a urologist to see if anything could be done about my incontinence. He told me that when I had the hysterectomy, I could have muscles tightened to eliminate my incontinence. Great. Now I was facing two different surgeries.

I think the reaction of my primary care physician shocked me the most. She readily agreed with the opinion to surgically clean me out, and said she wished she were a candidate for hysterectomy so she wouldn’t have to bother with her monthly periods!

Neither of these consultations convinced me to have my uterus removed. Determined to find a less extreme way to deal with my fibroids, I called other doctors in my area. But either they weren’t experienced in performing myomectomy (relatively few surgeons are trained in this surgery, which requires much greater skill than hysterectomy), or they encouraged me to have a hysterectomy. Finally, I contacted Hysterectomy Educational Resources and Services and was given the name of a doctor in Boston who had been doing myomectomies for many years.

After consulting with this doctor, I was told that a myomectomy was a viable option. What’s more, he said there would be no need for additional surgery to control the incontinence–removing the fibroids would be enough. Most importantly, I found out that I might not need surgery at all. The doctor explained that fibroids need the hormone estrogen to grow, but at menopause, when estrogen levels decline, fibroids often shrink. So unless my symptoms increased significantly, I could continue to watch and wait.

That’s exactly what I decided to do. Six months after my consultation in Boston, I began to have pre-menopausal symptoms, such as irregular periods and hot flashes. It is still too early to tell if my fibroids are shrinking–I may find out by the end of the year when I have another sonogram. But I’m relieved that I decided to keep my uterus intact.

Recently, I’ve read many articles concerning the inappropriately high rates of hysterectomy and the lifelong side effects often associated with this operation. I’ve also heard that surgeons sometimes perform such surgeries for their own profit or convenience. In all honesty, I don’t feel that my gynecologist and primary care physician are unethical. But I do think that, like many other physicians, they are products of their training. Much of that training, I’m afraid, has been to opt for aggressive measures like hysterectomy rather than more conservative approaches.

On the other hand, women have allowed this practice to prevail by not challenging their doctors. While I was making my own decision, I spoke with about a dozen women who had the operation, but none of them could articulate why, other than the fact that their doctors told them it was the best solution for fibroids. The women seemed to think they didn’t need a uterus or ovaries because they were beyond childbearing age and that having a hysterectomy was inevitable.

I regard myself as fortunate for not immediately assuming that doctors always give patients the best advice. I encourage other women to empower themselves by taking a more active part in matters concerning their health. It’s in your best interest to learn as much as you can to understand a medical issue and to help make a sound decision.

Nancy Lustig lives in Long Island, NY, where she is a commercial real estate broker.

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